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10030144CITY OF CUPERTINO BUILDING PERMIT I BUILDING ADDRESS: 10315 CALVERT DR I CONTRACTOR: COSMOS ROOFING I PERMIT NO: 10030144 1 OWNER'S NAME: JENINFER GRIFFIN :ER'S PHONE: 4084894172 ❑ LICENSED CONTRACTOR'S DECLARATION License Class C 39 Lic. # 75 C(CI Contractor / n SM ,_f O , 4A Dat -1 4�e I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. 1 agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature49::7�Date .2 LI OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec.7044, Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three declarations: I have and will maintain a Certificate of Consent to self -insure for Worker's Compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We) agree to save i nify and keep harmless the City of Cupertino against liabilities, judgments, L and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point sQurce regulations per the Cupertino Municipal Code, Section 9.18. 1 -.. Signature 3, 1901 OLD MIDDLEFIELD WAY STE 22 MOUNTAIN VIEW, CA 94043 DATE ISSUED: 03/25/2010 PHONE NO: (650)969-7663 BUILDING PERMIT INFO: BLDG r— ELECT F PLUMB T_ MECH f— RESIDENTIAL r— COMMERCIAL f— JOB DESCRIPTION: RE -ROOF REMOVE OLD TAR & GRAVEL ROOF, INSTALL 4 PLY TAR & GRAVEL ROOF 15SQ CLASS A Sq. Ft Floor Area: I Valuation: $5960 APN Number: 37517020.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued b Date: Z� d RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. Signat_4re of Applicant:�.�icr Date: R ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Own�or au rized_ agent: �'� Date: CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's Address ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional 3 ITEMS OF 3 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 37517020.00 DATE ISSUED.......: 03/25/2010 RECEIPT #......... BS0000IO025 REFERENCE ID # 10030144 SITE ADDRESS 10315 CALVERT DR SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OWNER ............: JENINFER GRIFFIN ADDRESS 10315 CALVERT DR CITY/STATE/ZIP ...: CUPERTINO, CA 95014 OPERATOR: patg COPY # : 1 RECEIVED FROM COSMOS ROOFING CONTRACTOR COSMOS, RICHARD LIC # 18844 COMPANY COSMOS ROOFING ADDRESS 1901 OLD MIDDLEFIELD WAY STE 2 CITY/STATE/ZIP ...: MOUNTAIN VIEW, CA 94043 TELEPHONE (650)969-7663 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL ----------------------- 1BCBSC VALUATION ---------- 5,960.00 ---------- 1.00 ---------- 0.00 1.00 0.00 1BSEISMICR VALUATION 5,960.00 0.60 0.00 0.60 0.00 1REROOFRES SQ FEET 15.00 195.00 0.00 ---------- 195.00 ---------- 0.00 ---------- TOTAL PERMIT ---------- 196.60 0.00 196.60 0.00 METHOD OF PAYMENT ----------------- CASH TOTAL RECEIPT AMOUNT --------------- 196.60 --------------- 196.60 VOICE ID DESCRIPTION -------- ---------------------------- 601 ROOF TEAR OFF REFERENCE NUMBER -------------------- VOICE ID DESCRIPTION -------- ---------------------------- 602 ROOF PLYWOOD NAIL 604 ROOF IN -PROGRESS 605 FINAL REROOF CITY OF CUPERTINO REROOF CUPEkTINO PERMIT APPLICATION APN # -3-7 - -7 ( l� Date: 2 U Building Address: 1 D3 t 5 C -A L\)ER-T Owner's Name: J EA)pj F�Ej` 621f✓ FlA) Contractor: Cupertino Business License #: i E844 Existing: .x� Built -Up Roof ❑ Asphalt Shingles ❑ Wood Shakes ❑ Wood Shingles ❑ Other (Specify) Number of existing coverings ❑ To be Removed C. u. PE-P—t`Tl A.: D Phone #: 409-499-qi-72- Phone #: -� 3 6,S.D g&,q" Fax #: (o SQ Contractor License #: �g54441 Type of Roof Covering: Proposed: ;k Built -Up roof ❑ Asphalt Shingles ❑ Wood Shakes ❑ Wood Shingles ❑ Other (Specify) ❑ Provide I.C.B.O. Report # ❑ Provide Mfgr. Installation Specs. Job Description: ' z,) -e v .o 0E OL - L -q i r� /z- °►- �� fro Commercial Fire Zone: Yes ❑ No Confirmed with Planning Dept. if there are any restrictions: ❑ Valuation: I Have Read, Understand and Will Comply with Cupertino's Tear -Off Policy: Signature CITY OF CITY OF CUPERTINO REROOF CUPERTINO FEE SCHEDULE Fee ID Fee Description Fee Group Permit Type Number of Squares Re -roof Commercial B 1COMMLROOF 1REROOFCOM Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BCBSC Seismic Commercial B 1BSEISMICO Re -roof Residential B 1SFDWLR00F / 1RER00FRES Cal Bldg Standards Commission Fee B ALL PERMIT TYPES / 1BCBSC Seismic Residential B 1BSEISMICRE Re -roof Multi -Family B 1MFDWLROOF 1REROOFMRES Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BCBSC Seismic Residential B 1BSEISMICRE Business License B 1BUSLIC Community Development Department Building Division City of Cupertino 10300 Torre Avenue Telephone: (408) 777-3228 Fax: (408) 777-3333 Building Department Subject: Re -roofing policy for the City of Cupertino 1. Prior to permit issuance, you must agree to comply with 2007 CBC Standards and manufacturers specifications on re -roofing. All roofs are Class "A" per Cupertino municipal code 16.04.080. 2. New roof coverings shall not be applied without first obtaining all inspection and written approval from the building inspector. A final inspection and approval shall be obtained from the building inspector when the re -roofing is completed. 3. All roofs shall be inspected prior to any roofing installation. 4. To receive a final sign off from the City, the following steps are required: Pre -inspection and/or tear off approval. a) AT TEAR OFF PULL OUT ALL ROOF FASTENERS. 2) In -progress inspection approval. 3) Final inspection approval. a) Spark arrester installation. 5. If plywood is installed, a plywood nail inspection is required. 6. Any roofing which is applied without first obtaining an inspection, will require the removal of all new material down to the sheathing, so a proper City inspection can be performed. 7. NOTE: If you call for a plywood nail inspection and the job is not ready, you will be charged a re -inspection fee of $126.00. The re -inspection fee must be paid before another inspection can be scheduled. IMPORTANT: 1. Flat roofs must have a minimum of 1/4 " per foot slope and demonstrate that there is no ponding. 2. An I.C.B.O. report is required to be on the job site at the time on inspection. I understand and will comply with the above stated policy on re -roofing. Homeowner's Name: JP.11(%�f.r�tn,A Job Site Address: 101/6 i'c l ver{ 2i=�L i� "_9_40/1(f Roofing Company Name: (, b Applicant's Signature: Date: _40 Albert Salvador Building Official Revised 3/09/10 Community Dcvaopmm 10300 Tan AWOM Cupertino CA 95014 Talcphooe (408) 777-3228 Fwc (4" 777-3333 CUPEttTIN OO Buildin De artment j0$ JODM&- P�irnr # i 03 .15 CA �v69--r 'DK OWNEt�S NAME: �'� N F&1- 6 At. �i � PHONE w �s`� � q-� �� 3 GENgZALC3ONTRAC?OR rnv FAX # &SD I am not using any subcon Date Please dwck ana mw roe zu.awvw •+w---- BUSINESS NAME BUSINESS LICENSE # SUBCONTRACTOR Cabhwts do NfMwork Cennent Fkdshing E[eftical F�ocavatian Fwgdng Fl / ♦ s ood l Mwle= cam / Glaurg Healing hwulation Landscaping Lashing Masonry . Ornamental Sheet mew PWnthg / WaRpaper Plastering Plumbing . -- Roofing . Tank Si�eet Metal Sheet Rock i d 0